Q. Where can I meet the doctor?

You can meet him at the following hospitals after prior appointment.

1) Clinic (MJRC clinic) #27, 1st avenue, Besant nagar, Chennai Time- 6- 8 pm. Tel- 9176640002

2 ) Chennai Meenakshi multispeciality hospital, Luz church road, Mylapore, Chennai- Tel- 044 42938938 Timing- 11 am – 1.30 pm

3) Guest hospital #372, Poonamalle high road, Kilpauk  Tel- 044 26411656 -9-10.30 am

 

Question: What is the cost of a knee replacement in India?

A. The cost depends on the type of implant, room and individual case. It can be confirmed after discussion in person. Cost will be well within standard range.

 

Question : How long should a patient remain in hospital after a knee replacement?

A. After a single total knee replacement, 4-5 days of stay is sufficient. This is to for pain relief and mobilization. For sequential bilateral  knee replacement eight days is allowed. For simultaneous bilateral replacements, you will get 6 days.

 

Question : When can the patient stand up after a knee replacement?

A. You can do so on the same day or next day after the operation.

 

Question : Do I operate on both knees simultaneously?

A. If you are young & fit, then both knees can be done in one sitting (Bilateral simultaneous TKR). An approximate cut off age for bilateral simultaneous knee replacements is 65 years. In older patients and those with co morbidities I advice a gap of days or months between the two procedures.

 

Question : For how long will you have to use a walker?

A. You may need a walker for about 15 days and a cane or crutches for another fortnight. Then you can walk without any aids.

 

Question : How long is the waiting time for surgery?

A. I can operate on patients with notice of a day or two for a straight forward primary knee and one week for revision knees. Preparation for knee replacement commences one month in advance. See this page.

 

Question : What prosthesis do I use?

A. I use only imported prostheses. These are

• NexGen LPS  flex fixed (Zimmer)
• Genesis metal & Oxinium, ( Smith & Nephew )
• PFC from Depuy (Johnson & Johnson)
• Scorpio NRG knee (Stryker)
• Vanguard kne ( Biomet)
• For Unicondylar knees, I use the Oxford knee from Biomet and the ZUK knee (Zimmer).

 

Question : When will the patient be pain free after surgery?

A. Post-operative pain is controlled to tolerable levels by excellent multi modal anesthesia. Two to three weeks of  medication are required in most people.

 

Question : How long does the operation take?

A. A primary total knee replacement takes about one hour. Anesthetic induction time is about 30 minutes. Extubation and shifting takes another 15 minutes. The turnaround time is about 2 hours. Some difficult cases may take about two to two and half  hours.

 

Question : What anesthesia will I receive?

A. You can have the operation done under general anesthesia (fully unconscious) or a regional anesthesia (spinal or epidural) in which you will be sedated but not knocked out. Regional anesthesia is a safe mode for diabetics and elderly people. Both are often supplemented by regional nerve blocks.

 

Question : I am diabetic. Can I have the operation?

A. Many patients are diabetic. A diabetologist will help me in pre and  post operative management. My anesthetist is very competent at epidural anesthesia to make it safe. Wound healing is good in well controlled diabetes. If control is poor, I recommend you to consult your diabetologist well in advance  to achieve good control.

 

Question : What kind of physical activity can I do after the operation?

A. You can walk as much as you want. Routine house hold activities, travelling, climbing stairs, sitting cross legged are all allowed. Non-impact sports like walking, golf are allowed.

 

Question : When can the patient go back to work?

A. This depends on the nature of the job. In a sedentary or desk top job it would be possible after a month to six weeks. If the job requires a lot of standing and walking, then two months are required.

 

Question : Can I travel overseas after the operation?

A. You can do so after three weeks.

 

Question : Can I drive a car after surgery?

A. You can drive when you are ready to give up crutches. This varies but the earliest is at 3 weeks. With the less invasive techniques, patients recover faster . If you need to use aid for longer, then it is advisable to self drive after you are support free.

 

Question : What is the ideal age for a knee replacement?

A. The ideal age is more than 65 years. I don’t refuse the procedure to younger patients with incapacitating pain.  My youngest patient so far is twenty five years and my olderst patient in India is 87 years. Durable implants, smart tools technology and diligent post operative care have made this possible.

 

Question : What are the alternatives to knee replacement in younger people?

A. Autologous cartilage implantation is suitable for small to medium areas of cartilage loss. In this your own cartilage cells are removed, cultured and put back in a damaged area of your knee. An osteotomy is advisable if you have mal alignment; if your job is strenuous and the cartilage wear is one sided only.

 

Question : How much bend can I get in the knees post-operatively?

A. Post op bending achieved is dependent on the pre op bend, body mass index, prosthesis & rehabilitation. With the High Flexion knee, you can get about 155 degrees. Standard knee implants allow about 110 degrees of bending.

Bilateral Total Knee Replacements

 

Question : What is a Bilateral Total Knee Replacement?

A. When the cartilage has worn away in both knees, artificial knees (prostheses) can relieve pain. Surgery to resurface both knees is termed bilateral Total Knee Replacements.

 

Question : What is a Simultaneous Bilateral Total Knee Replacement?

A. A simultaneous procedure means that both knees are replaced on the same day, under one anesthesia. This takes place as a single surgery, within one hospital stay and is followed by a single rehabilitation period.

 

Question : What is a Sequential or staggered bilateral total Knee Replacement?

A. A staged or sequential procedure means that the two operations are performed as two separate events. Surgeries are typically performed several days or months apart.

 

Question : Who should have a Bilateral Total Knee Replacement?

A. The most common reason for Bilateral Total Knee Replacements is symptomatic severe arthritis in both knees.

 

Question : What are the advantages of a simultaneous total Knee Replacement?

A. The advantages of  a simultaneous procedure include: only one surgical event, single anesthesia, shorter overall hospital stay, and the possibility of faster rehabilitation.

 

Question : What are the disadvantages of Simultaneous Total Knee Replacements?

A. The disadvantages of having a simultaneous procedure include an increased morbidity, increased blood loss and lack of one good leg (as perceived by some patients)

 

Question : What are the advantages of a Staged Total Knee Replacement?

A. The advantages of having a staged procedure include lower stress level for the cardiovascular system, fewer cardiovascular, renal and pulmonary complications, lower incidence of DVT, blood transfusions. This is an excellent choice for patients with cardiac, vascular or pulmonary diseases or those above 75 years.

 

Question : What are the disadvantages of a Staged Total Knee Replacement?

A. The disadvantages of having a staged procedure are that it requires two hospital stays, two anesthesias and delays full return from disability.

 

Question : What are the results in terms of function and relieve of pain?

A. In both type of procedures, simultaneous and staged, results are excellent and equivalent in terms of relieve of pain and daily activities. Patients should expect a greater than 95% chance of success at 15 years.

 

Question : Is there any contraindication for a simultaneous procedure?

A. Yes. There are some contraindications and this is why we believe that patient  selection is necessary. The usual contraindications for knee replacement include an active knee infection, or severe neurologic compromise of the leg. This procedure is also relatively contraindicated in patients with significant cardiac, lung vascular conditions. Patients above 65 years old typically are not recommended for simultaneous procedures.

 

Question : Who would be the ideal candidate for a Simultaneous procedure?

A. The ideal candidate for a simultaneous Total Knee Replacement should be younger than 65 years old, without associated cardiac, pulmonary or vascular diseases. This patient should also complain of severe arthritic pain equally symptomatic in both knees, that interferes with his/her activities of daily living and significantly reduces the his/her quality of life.

 

Q. What is the cost of ACL reconstruction in my practice?

A. The cost starts at 95,000 INR with Indian implants. Imported implants and bio absorbable implants will cost more.

 

1) Chennai Meenakshi multi speciality hospital

2) Guest hospital

1) Luz church road,  Mylapore, Chennai
2) #372, Poonamalle high road, Kilpauk

1) 044 42938938
2) 044 26411656

1) www.cmmh.in
2) www.guesthospital.com